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Dermatology > Derm 1 > Flashcards

Derm 1 Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the pH of normal skin?

A

5.5

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2
Q

What are the layers of the skin? Superficial to deep

A

Epidermis > Dermis > Subcutaneous Fat

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3
Q

What layer of the skin are Corneo-desmosomes and desmosomes found? What diseases affect them?

A

Epidermis

Increased number = psoriasis

Decreased number = atopic eczema

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4
Q

What are found in the Dermis?

A

Meissner’s corpuscle - light touch

Pacinian corpuscle - coarse touch/vibration

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5
Q

What cells are found in the epidermis?

A

Keratinocytes - produce keratin

Langerhans cells - present antigens and activate T cells

Melanocytes - produce melanin, which protects from UV radiation

Merkel cells - specialised nerve endings for sensation

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6
Q

What are some differentials for itch WITH rash?

A

Urticaria (hives, weals, welts)
Atopic eczema
Psoriasis
Scabies

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7
Q

What are some differentials for itch with NO rash?

A 
Renal failure
Jaundice
Iron Deficiency
Lymphoma - hodgkins
Polycythamia - bath itch
Pregnancy
Drugs
Diabetes
Cholestasis
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8
Q

What is the pathophysiology of Acne?

A
  1. Narrowing of hair follicle due to hypercornification
  2. Results in increased sebum production
  3. Sebum stagnates at pit of the follicle where there is NO oxygen
  4. These anaerobic conditions allow Propionibacterium acnes to multiply
  5. P.acne break down triglycerides in sebum into FFA = irritation, inflammation and the attraction of neutrophils
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9
Q

How would Acne present? How would you diagnose?

A

Whiteheads
Blackheads
Papules
Pustules

Usually clinical diagnosis
Skin swabs for MC&S

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10
Q

How would you manage Acne?

A

Topical retinoid/salicylic acid - tretinoin topical, salicylic acid

Topical benzoyl peroxide

Topical azelaic acid

Oral retinoid - isotretinoin

Oral corticosteroid - prednisolone

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11
Q

What are the two types of Eczema/Dermatitis?

A

Endogenous (atopic) - usually due to hypersensitivity

Exogenous - contact dermatitis usually precipitated by chemicals, sweat and abrasives

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12
Q

What are some risk factors for Eczema/Dermatitis?

A

Faulty gene that codes for Filaggrin

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13
Q

How does Eczema/Dermatitis present?

A

Commonly on the face and flexure surfaces of the limbs

Itchy, erythematous and scaly patches esp in the flexure of elbwos, knee, ankles, wrists and around the neck

Increased dryness of skin

Recurrent Staph. Aureus infections may be common

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14
Q

How would you diagnose eczema/dermatitis?

A

For eczema it would be clinical diagnoses

Contact dermatitis - patch testing, repeated open application test

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15
Q

How would you manage eczema/dermatitis?

A

moisturisers, topical hydrocortisone

tacrolimus

oral corticosteroids

*eczema could try antihistamine (chlorphenamine)

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16
Q

What is psoriasis? What are the different forms?

A

hyper-proliferation of skin leading to thickened plaques

  1. Chronic plaque psoriasis
  2. Flexural psoriasis
  3. Guttate (rain-drop) psoriasis
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17
Q

What are some risk factors for psoriasis?

A

polygenic

infection with group A strep

lithium

UV light

High alcohol use

Stress

Fam Hx

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18
Q

How does Chronic plaque psoriasis present?

A

Most common

Well demarcated disc-shaped, Salmon-pink silvery plaques occur on the exterior surface of the limbs, particularly the elbows and knees

Scalp involvement is common and is most seen at the hair margin

New plaques occur at sites of skin trauma

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19
Q

How would you treat chronic plaque psoriasis ?

A

emollients

topical corticosteroid - hydrocortisone

topical vitamin D analogue - calcipotriol

PUVA (risk of neoplastic skin lesions)

mtx

apremilast

ciclosporin

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20
Q

How does flexural psoriasis present?

A

later in life

well demarcated, red, glazed, non-scaly plaques

scaling is absent

confined to - groin, natal cleft and sub-mammary areas

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21
Q

How does guttate psoriasis present?

A

commonly in chilfren and young adults

generalised, concentrating on the trunk, upper arms and legs

explosive eruption of very small circular or oval plaques appears over the trunk about 2 weeks after a streptococcal sore throat

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22
Q

How do you treat guttate psoriasis?

A

phototherapy + psoralen (photosensitising agent)

MTX

Oral retinoid - acitretin

Ciclosporin

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23
Q

What are venous ulcers? How do they occur?

A

Loss of skin below the knee on the leg or foot that takes more than 2 weeks to heal

Result of sustained venous hypertension in the superficial veins

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24
Q

How do venous ulcers present?

A

sloping and gradual edges

ulcers are large, shallow, irregular and exudative

usually minimal pain

oedema of the lower leg

venous eczema

brown pigmentation from haemosiderin

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25
Q

How would you treat a venous ulcer?

A

high compression 4 layered bandage

leg elevation to reduce venous hypertension

antibiotics for infection

analgesia

support stockings for life

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26
Q

How do arterial ulcers present?

A

Punch-out ulcers higher up the leg or on the feet

Intense pain that is worse when elevated

leg is cold and pale

ulcer is small, sharply defined and has anecrotic base

absent peripheral pulses

NO OEDEMA

27
Q

How would you investigate an arterial ulcer? How would you manage it?

A

Doppler USS - confirm arterial disease

ABPI will suggest arterial insufficiency

Keep ulcer clean and covered

Analgesia

NEVER USE COMPRESSION BANDAGING

28
Q

What are neuropathic ulcers?

A

often painless

seen over pressure areas of feet such as the metatarsal heads or heels

commonly assoc with diabetes and neurological disease = peripheral neuropathy

29
Q

What are some characteristics of Squamous Cell Carcinoma?

A

presents in later-life

malignant tumour of the squamal keratinocytes

more aggressive than BCC and has a higher metatastic potential

30
Q

What is Bowen’s disease?

A

in situ SCC that is confined to the epidermis

31
Q

What are risk factors for squamous cell carcinoma?

A

UV exposure

Chronic inflammation

32
Q

How does squamous cell carcinoma present?

A

most common on sun-exposed sites in later life

can grow very rapidly

ulcerates lesions on the lower lip or ear are often more aggressive

33
Q

How would you treat squamous cell carcinoma?

A

destructive therapies - cryotherapy

topical therapy - fluorouracil

surgical excision/Mohs surgery (micrographic surgery)

radiotherapy

34
Q

What are some characteristics of a basal cell carcinoma?

A

majority non-pigmented

majority in elderly on the head and neck

may ulcerate - called a rodent ulcer

rarely metastasises but is locally destructive

35
Q

What cells are a basal cell carcinoma?

A

tumour of basal keratinocytes

36
Q

What are some risk factors for basal cell carcinoma?

A

UV exposure

Skin type 1 - that burns and doesn’t tan

Ageing

37
Q

How does a basal cell carcinoma present?

A

border of ulcerated lesions are raised with a pearly appearance

can be nodular (most common), superficial (plaque-like), cystic, morphoiec, keratotic and pigmented

38
Q

How would you treat basal cell carcinoma?

A

Vismodegib

Curretage +/- cautery and biopsy

Radiotherapy

Mohs surgery

39
Q

What is a malignant melanoma?

A

Malignant tumour of the melanocytes

most malignant for of skin cancer

commonly affects younger patients

40
Q

What are risk factors for malignant melanoma?

A

UV exposure

Red hair

High density freckles

Skin type 1

Atypical moles

Sun sensitivity

Immunosuppresion

Fam Hx

41
Q

How does a malignant melanoma present?

A

commonest site in men - back/chest

commonest site in women is on lower legs

95% melanomas show very dark colour, black or almost black

42
Q

How would you investigate a malignant melanoma?

A

ABCDE
Asymmetrical shape

Border irregularity

Colour irregularity

Diameter >6mm

Elevation/Evolution

Major signs - change in size, shape or colour

Minor signs - inflammation, crustin or bleeding, sensory change, itching

43
Q

What are the types of melanoma?

A

Superficial spreading (SSMM)

Nodular - most aggressive

Lentigo maligna - usually on the face

Acral - restricted to palms/soles

44
Q

What are some differentials of malignant melanoma?

A

Benign pigmented naevus

Seborrhoiec wart

pyogenic granuloma

45
Q

How would you treat malignant melanoma?

A

surgical excision

ipilimumab

high-dose interferon alfa-2b or peginteferon alfa-2b

46
Q

What are some ways of staging malignant melanoma?

A

Breslow depth

Clark’s staging

47
Q

What makes for a poor prognosis of malignant melanoma?

A

thicker lesions

over 60

male

ulceration

trunk

48
Q

What is cellulitis?

A

bacterial infection of the deep sub-cutaneous tissues

49
Q

What are the causes/risk factors for cellulitis?

A

group A beta-haemolytic strep (strep pyogenes most common)

Staph Aureus

MRSA

Lymphoedema
Leg Ulcer
Immunosuppresion

Traumatic wounds

Athletes foot

Leg oedema

Obesity

50
Q

How does cellulitis present?

A

Local inflammation- proximally spreading

Hot erythema

Poorly demarcated margins, swelling, warmth and tenderness

Blisters if oedema is prominent

Systemically unwell with pyrexia

51
Q

How would you diagnose/investigate cellulitis?

A

FBC count - raised WCC

Purulent focus culture - growth of typical pathogen

52
Q

How would you treat cellulitis?

A

Vancomycin/Daptomycin/Linezolid

Bite-related - amoxicillin + metronidazole + tetanus immunisation

53
Q

What is necrotising fasciitis?

A

Deep seated infection of the subcut tissue that results in a fulminant and spreading destruction of fascia and fat that initially spares the skin

54
Q

What are the types of necrotising fasciitis?

A

Type 1 : caused by mixture of aerobic and anerobic bacteria following abdo surgery or in diabetes

Type 2 : caused by group A beta-haemolytic streptocci (strep pyogenes most common

55
Q

How does necrotising fasciitis present?

A

Severe pain that is out of proportion to skin findings at the initial site of infection

rapidly followed by tissue necrosis

spreading erythema, pain and sometime crepitus

fever, toxicity and pain

multi-organ failure is common

56
Q

How would you investigate necrotising fasciitis?

A

Abnormally high or low WBC

Serum urea and creatinine - may be seen in any systemic infection or circulatory collapse

CRP - elevated

CK - elevated

Lactate - elevated

Blood and tissue cultures - positive

57
Q

How would you treat necrotising fasciitis?

A

surgical debridement and haemodynamic support

vancomycin

58
Q

What is a comedone?

A

plug in sebaceous follicle containing altered sebum, bacteria and cellular debris

open = blackhead
closed = whitehead
59
Q

What is the Koebner phenomenon?

A

A linear eruption arising at site of trauma e.g. in psoriasis

60
Q

What are the following?

Macule
Papule
Nodule
Vesicle
Bulla
A

Macule - flat area with altered colour

Papule - solid raised lesion <0.5cm

Nodule - solid raised lesion >0.5cm

Vesicle - raised,clear fluid-filled lesion <0.5cm

Bulla - raised, clear fluid-filled lesion >0.5cm

61
Q

What are the 4 stages of wound healing?

A

Haemostasis
Inflammation
Proliferation
Remodelling

62
Q

What happens during the haemostasis and inflammation in the wound healing process?

A

Haemostasis - vasoconstriction and platelet aggregation, clot formation

Inflammation - vasodilation, migration of neutrophils and macrophages, phagocytosis of cellular debris and invading bacteria

63
Q

What happens during proliferation and remodelling in the wound healing process?

A

Proliferation - granulation tissue formation and angiogenesis, re-epithelisation

Remodelling - collagen fibre re-organisation, scar maturation

Dermatology (2 decks)

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